[A new method to enhance liver regeneration: double venous deprivation of the liver].

Abstract

The resectability of liver tumors depends on having a sufficient amount of liver tissue remaining after surgery to ensure proper liver function. With portal vein occlusion techniques, slower and more modest growth can be achieved during a low-risk intervention. If hypertrophy is insufficient or there is a risk of rapid tumor progression, Associating Liver Partition and Portal vein ligation for Staged hepatectomy can be used, which provides the most significant induced hypertrophy in a short time. However, the morbidity associated with the combined surgery is high. The dual venous deprivation of the liver, which involves the occlusion of the ipsilateral portal vein and hepatic vein, aims to combine the advantages of the above techniques. This approach allows for rapid and significant contralateral lobe hypertrophy, comparable to the latter method, to be achieved safely. Through our case, we demonstrate this liver hypertrophy technique. A 75-year-old female patient, during the investigation of her abdominal complaints, was diagnosed with a large intrahepatic cholangiocellular tumor in the right lobe of the liver, also affecting the middle sector. Considering the localization, the tumor could only be removed with a right-sided trisegmentectomy. We performed liver volumetry, which showed that the volume of the remaining liver (S1-2-3) was less than 35%. We decided on dual liver vein deprivation. On the 7th day following the occlusion of the right portal vein and the ipsilateral right hepatic vein, significant hypertrophy (41%) was observed. We successfully performed the planned surgery. During the postoperative period, mild ascites was managed conservatively, and no other complications occurred. The patient was discharged on the 8th postoperative day. If the expected volume of the remaining liver is insufficient for planned liver resection, liver regeneration techniques are necessary. Among the available techniques, the newest solution offering low complication risks is dual venous deprivation, involving occlusion of the ipsilateral portal vein and hepatic vein. The above case demonstrates that rapid and effective liver regeneration can be expected with this method, with minimal burden, enabling the safe performance of extended liver resections. Orv Hetil. 2024; 165(36): 1433–1439.